As we gather for our annual meeting virtually for the first time in the history of the American Society for Clinical Investigation (ASCI), it is an honor to address you as the 111th president of this society. Just over a year ago, on March 11, 2020, as the global SARS-CoV-2 pandemic began to take hold, the leadership of the ASCI, the Association of American Physicians (AAP), and the American Physician Scientists Association (APSA) made the difficult decision to cancel the 2020 Joint Meeting. The annual ASCI gathering of clinical investigators has previously been canceled only twice in its 112-year history, in 1943 and 1945, and then only due to the major global disruption of World War II (1).

In March of 2020, many of us, including myself, were hoping that the COVID-19 pandemic would be short-lived and easily contained, a distraction, but not a major disruption. Instead, this pandemic has posed a serious threat to life and livelihood. For the majority of Americans alive today who have not lived through a major world war, the pandemic is the greatest disruption and biggest collective existential threat that we have ever faced. There are some encouraging signs in April 2021 as case numbers drop below January highs and vaccination increases. However, the rise of new variants of SARS-CoV-2 that are potentially more contagious and more virulent, coupled with concerns about vaccine hesitance and inadequate global access to vaccines, portends a future that is still clouded with uncertainty.

Preparing for this annual presidential address is a rite of passage for ASCI presidents, and it has been an enlightening and humbling task to review the speeches of many of my esteemed predecessors. In his 2002 address, Dr. David Ginsburg, the 92nd president of the ASCI, identified five recurring themes that have consistently appeared in prior ASCI presidential addresses (2), including the future of the physician-scientist, defining clinical investigation, ASCI “state of the union,” research funding, and education and mentoring. All of these topics continue to be important for the ASCI today. I will focus primarily on the impact of the SARS-CoV-2 pandemic on two of these themes, the future of the physician-scientist and the changing landscape of clinical investigation.

The pandemic has had both positive and negative effects on the physician-scientist community. One positive impact has been to underscore the central role that a vibrant community of well-trained physician-scientists plays in advancing biomedical science and public health. Around the world, physician-scientists have been integral to every aspect of the scientific response to COVID-19. Earlier today, the AAP and ASCI honored one physician-scientist and ASCI member for his role in spearheading the US response to this pandemic, Dr. Anthony Fauci; it has been heartwarming to see a physician-scientist gain such widespread recognition and respect from so many in the lay community. Many other physician-scientists, too numerous to name, have played pivotal roles in efforts to understand, track, treat, and contain the pandemic, including many in this audience. Physician-scientists have been at the forefront of studies of the fundamental biology of coronaviruses and in the development and testing of the novel mRNA and other vaccines that have shown unprecedented efficacy against this virus. The fact that widespread vaccination is taking place barely more than a year after this novel pandemic was recognized is breathtaking and illustrative of the acceleration of the pace of scientific discovery in the 21st century.

The pandemic has also highlighted the need for a physician-scientist community with diverse skills that extend beyond traditional bench investigation of pathophysiologic mechanisms of disease. As a critical care physician, I have seen firsthand the importance of physician-scientists with expertise in clinical trial design as new trials for agents to treat SARS-CoV-2 infection have been implemented at previously unthinkable speeds. Novel clinical trial designs, including platform and pragmatic trials, have bolstered our armamentarium with new therapies, including remdesivir and monoclonal antibodies, and repurposed therapies, such as dexamethasone and tocilizumab, and allowed us to rapidly discard ineffective therapies, such as hydroxychloroquine. Physician-scientists have also grappled at the bedside with other pandemic-related questions, such as what is the physiological impact of ventilating two patients with one ventilator, a question born of sheer desperation (3).

The pandemic has also highlighted the changing landscape of clinical investigation. The ASCI was founded in 1908, at a time when the exciting “new science” of physiology was replacing clinical-pathologic correlation at the frontier of biomedical discovery (1). This new science was largely the purview of a new breed of physician-investigators who embraced this fledgling field and eventually established a new journal in 1924 to publish their findings, the Journal of Clinical Investigation. As a lifelong student of pulmonary physiology, it was fascinating to see the physiologic focus of articles published in the first issue of JCI in 1924 (Figure 1). Over the past 110 years, the field of clinical investigation has grown and morphed repeatedly. Many new scientific disciplines have emerged to enrich clinical investigation, including those related to big data, precision medicine, and clinical trial design. Through the revitalized Institutional Representative program, the Council has made a concerted effort in the past five years to encourage nominations for ASCI membership of scientists from the entire spectrum of clinical investigation, including clinical, epidemiologic, and health services research. Compared to 2012 to 2016, in the past five years, there have been some encouraging trends in numbers of new members who are from fields other than internal medicine and from scientific disciplines other than bench investigation (Figure 2), and this remains a focus for the Council in the future. The JCI and JCI Insight also are aiming to publish more clinical medicine articles to better represent the breadth of scientific focus of our membership. Our journals have also responded nimbly to the challenge of the COVID-19 pandemic, altering editorial policies and publishing many key COVID-related manuscripts.

Table of contents of the first issue of the Journal of Clinical Investigation, published in 1924.

The representation of scientists from surgical fields, obstetrics and gynecology, epidemiology, and outcomes research among new members to the ASCI has increased in the past five years. Panels show percentages of newly elected members to ASCI by year from 2017 to 2021 compared with the five-year period between 2012 and 2016 for (A) new members from surgical fields and obstetrics and gynecology (Obgyn) and (B) new members from epidemiologic fields (Epi) and outcomes research.

Despite bringing a rising tide of national and international attention to the key role that physician-scientists play in advancing the science of medicine, the pandemic has also overwhelmed physician-scientists with a tidal wave of tangible and intangible challenges. Lockdowns have shuttered research laboratories, and many laboratories remain closed or at reduced capacity. Non–COVID-related clinical research has been halted or limited at many academic centers and has been slow to resume. Shortages of key laboratory reagents and supplies have stalled important projects. Many physician-investigators and trainees have had to set aside research in order to shoulder increased clinical responsibilities during surges of patients with COVID-19. Despite this increased clinical effort, revenues at many academic centers have been heavily impacted and bridge funds to support investigators are less available. At home, many investigators have had to deal with loss of child care, elder care, and other important services, repeated quarantines due to exposures, school closures, and illness, and job losses among family and friends. These hardships have particularly impacted younger investigators, who in addition to being at a more vulnerable time in their scientific careers, are more likely to have young children at home; female and minoritized investigators are also particularly vulnerable.

Indeed, the intersection of the global pandemic with the #MeToo movement that began in 2018 and the widespread demonstrations in 2020 in protest of police brutality and violence against Black and other minoritized communities has brought into sharp focus issues of systemic bias and inequities in science and health care (4). The COVID-19 pandemic has had a disproportionate impact on minoritized populations in the US, including Black, Hispanic, and Native American communities, with both higher infection rates and higher mortality. Yet these communities are largely unrepresented in the data that drive clinical care of the most severely ill (5), and these minoritized groups remain underrepresented in medicine and even more so in the ranks of physician-scientists. For example, Black people make up 13% of the US population but only 4% of US doctors and an even smaller percentage of physician-scientists (6). Yet it has been shown across a variety of fields, including science, that increased diversity feeds creativity and impact (7).

One of the first steps we undertook as an organization to address diversity and equity within the ASCI was to form a working group on diversity in 2018 with an aim of revising and modernizing our mission statement to be more inclusive; this task was completed in 2019 and the revised mission statement may be viewed on the ASCI website. In brief, the American Society for Clinical Investigation seeks to support the scientific efforts, educational needs, and clinical aspirations of physician-scientists to improve the health of all people. It is one thing to revise the wording of our mission, but an entirely different thing to actually be more inclusive; this is work that is in progress. As a female physician-scientist, I recall looking through the roster of members when I was first being nominated for ASCI membership many years ago and being struck by the low numbers of women and minorities and wondering if there would be a place for me in this society composed almost exclusively of White men. The Council has worked with our institutional representatives to increase the number of female and underrepresented minorities who are nominated for membership. This work is paying off (Figure 3) both in our membership and in our leadership where I am proud to have served as the eighth female president of the ASCI on a Council that was majority female and included the first Black editor of JCI, Dr. Rex Ahima, and the first female editor of one of our journals, JCI Insight editor Dr. Kathy Collins.

The representation of physician-scientists who are underrepresented in medicine or female among new members of the ASCI has increased in the past five years. Panels show percentages of newly elected members to ASCI by year from 2017 to 2021 compared with the five-year period between 2012 and 2016 for (A) new members from racial or ethnic groups that are underrepresented in medicine (URM) and (B) new members who are female.

Despite these advances, we have much work to do. To be prepared for the next public health crisis, the rapid acceleration of biomedical science must be a rising tide that raises all boats, lifting and elevating the careers of female and minoritized physician-scientists along with the greater scientific community. In 2020, we amended the bylaws of the ASCI to form a permanent Diversity Equity and Inclusion Committee that is charged with ensuring that the organization, its programs, and its mentoring mechanisms promote and recognize diversity, inclusion, and equity. This committee is chaired by Councilor Dr. Sophie Paczesny. The first task that the committee is tackling is to develop definitions of groups that are underrepresented in medicine that can be used to survey our membership. Despite being an organization of scientists, it is striking that we have almost no data on the racial and ethnic composition of our membership and only recently started collecting these data as part of the nomination process. Other projects that the committee is undertaking include new mentoring programs and awards for female and underrepresented investigators. It is my hope that in the future, young investigators perusing the ranks of ASCI members as they contemplate their own nominations to ASCI will see more faces in this physician-scientist community that look like their own.

Finally, with regard to the “state of the union,” I can assure you that despite the pandemic, the ASCI continues to thrive, both fiscally and organizationally. Although our society offices in Ann Arbor stand empty as remote work continues and our Council has not been able to gather in person, we have met virtually to conduct the business of our society. I am indebted to John Hawley, Executive Director, and Karen Guth, Managing Director, who have run the ASCI for over 20 years. Their collective institutional memory and steady hands at the helm have kept the ASCI on course despite the annual disruption of new leadership and the whims of each new council. I am also indebted to Dr. Kieren Marr and Dr. Kimryn Rathmell, remarkable leaders and role models who preceded me in this presidency and whose ideas and input shaped many of the active projects that the Council is working on currently. I leave you in the able hands of our incoming President, Dr. Hossein Ardehali, who has many exciting plans for the Society, along with President-Elect Dr. Sohail Tavazoie and our newly elected Vice President and outgoing Secretary-Treasurer Dr. Ben Humphreys. I would also like to welcome our three newly elected Council members, Drs. Julie Bastarache, Goutham Narla, and Elizabeth Speliotes.

In closing, thank you for the opportunity to have served as president during this challenging year. I will conclude by welcoming our new members. You are joining a society that, although steeped in tradition, was born of change. The ASCI will continue to adapt and evolve in response to the changing world and the changing landscape of clinical investigation. I encourage you to take advantage of the opportunities within this society to network, to publish in our journals, and to get involved in our committees, institutional representation, and leadership.

Footnotes

Conflict of interest: LBW receives research funding from Genentech Inc. unrelated to the content of this article.

Reference information: J Clin Invest. 2021;131(18):e154538. https://doi.org/10.1172/JCI154538.

This article is adapted from a presentation at the 2016 AAP/ASCI/APSA Joint Meeting, April 15, 2016, in Chicago, Illinois, USA.

Copyright: © 2021, American Society for Clinical Investigation.

References

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3. Beitler JR, et al. Ventilator sharing during an acute shortage caused by the COVID-19 pandemic. Am J Respir Crit Care Med. 2020;202(4):600–604.View this article via: PubMedCrossRefGoogle Scholar
4. Ware LB, et al. A deliberate path toward diversity, equity, and inclusion within the ASCI. J Clin Invest. 2020;130(10):5031–5032.View this article via: JCIPubMedCrossRefGoogle Scholar
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当我们实际上在美国临床调查学会 (ASCI) 历史上第一次聚集在我们的年度会议上时，很荣幸作为该学会的第 111 任主席向您致辞。就在一年前，也就是 2020 年 3 月 11 日，随着全球 SARS-CoV-2 大流行开始蔓延，ASCI、美国医师协会 (AAP) 和美国医师科学家协会 (APSA) 的领导层作出取消2020年联席会议的艰难决定。在其 112 年的历史中，一年一度的 ASCI 临床研究人员聚会之前仅在 1943 年和 1945 年两次被取消，然后只是由于第二次世界大战的全球性重大破坏（1）。

2020 年 3 月，我们中的许多人，包括我自己，都希望 COVID-19 大流行会是短暂的并且很容易得到控制，这是一种分散注意力，但不会造成重大破坏的情况。相反，这种流行病对生命和生计构成了严重威胁。对于今天活着的大多数没有经历过重大世界大战的美国人来说，这场流行病是我们所面临的最大破坏和最大的集体生存威胁。2021 年 4 月出现了一些令人鼓舞的迹象，因为病例数降至 1 月高点以下且疫苗接种增加。然而，可能更具传染性和毒性的 SARS-CoV-2 新变种的兴起，加上对疫苗犹豫不决和全球疫苗获取不足的担忧，预示着未来仍充满不确定性。

准备这次年度总统演讲是 ASCI 总统的成年礼，回顾我许多尊敬的前任的演讲是一项具有启发性和谦卑的任务。在 2002 年的讲话中，ASCI 的第 92 任主席 David Ginsburg 博士确定了五个反复出现的主题，这些主题一直出现在之前的 ASCI 主席讲话中 ( 2 )，包括医师-科学家的未来，定义临床调查，ASCI “状态工会”，研究资金，以及教育和指导。所有这些主题对于今天的 ASCI 来说仍然很重要。我将主要关注 SARS-CoV-2 大流行对其中两个主题的影响，即内科科学家的未来和不断变化的临床研究前景。

这场大流行对医生-科学家社区产生了积极和消极的影响。一个积极的影响是强调了一个充满活力的训练有素的医师科学家社区在推进生物医学科学和公共卫生方面所发挥的核心作用。在世界各地，医学科学家在应对 COVID-19 的科学反应的各个方面都不可或缺。今天早些时候，AAP 和 ASCI 表彰了一位医学科学家和 ASCI 成员，因为他在领导美国应对这一流行病方面发挥了作用，Anthony Fauci 博士；看到一位医学科学家在非专业社区中获得如此广泛的认可和尊重，真是令人心旷神怡。许多其他医学科学家，数不胜数，在理解、追踪、治疗和遏制大流行的努力中发挥了关键作用，包括这个观众中的许多人。内科医生和科学家一直处于冠状病毒基础生物学研究的前沿，以及新型 mRNA 和其他疫苗的开发和测试，这些疫苗对这种病毒具有前所未有的功效。在这种新的大流行被识别后仅一年多就开始广泛接种疫苗这一事实令人叹为观止，并说明了 21 世纪科学发现步伐的加快。

这场大流行还凸显了对具有多种技能的医师-科学家社区的需求，这些技能超越了对疾病病理生理机制的传统实验室调查。作为一名重症监护医师，我亲眼目睹了具有临床试验设计专业知识的医师科学家的重要性，因为治疗 SARS-CoV-2 感染的药物的新试验已经以以前无法想象的速度实施。新的临床试验设计，包括平台和实用试验，为我们的医疗设备提供了新疗法，包括瑞德西韦和单克隆抗体，以及重新调整用途的疗法，如地塞米松和托珠单抗，并使我们能够迅速放弃无效的疗法，如羟氯喹。医生和科学家也在床边努力解决其他与大流行相关的问题，3）。

大流行还突显了临床研究的不断变化的格局。ASCI 成立于 1908 年，当时令人兴奋的“新科学”生理学正在取代生物医学发现前沿的临床-病理学相关性 ( 1 )。这门新科学在很大程度上属于新一代的内科研究人员的职权范围，他们接受了这一新兴领域，并最终在 1924 年建立了一个新期刊来发表他们的研究结果，即《临床研究杂志》。作为肺生理学的终身学生，看到JCI第一期发表的文章的生理焦点令人着迷1924 年（图 1）。在过去的 110 年中，临床研究领域不断发展壮大。许多新的科学学科已经出现，以丰富临床研究，包括与大数据、精准医学和临床试验设计相关的学科。通过重振机构代表计划，理事会在过去五年中齐心协力，鼓励来自整个临床研究领域的科学家提名 ASCI 成员，包括临床、流行病学和卫生服务研究。与 2012 年至 2016 年相比，过去 5 年，内科以外领域和基准调查以外学科的新成员数量出现了一些令人鼓舞的趋势（图 2），这仍然是安理会未来的重点。这JCI和JCI Insight还旨在发表更多临床医学文章，以更好地代表我们会员科学关注的广度。我们的期刊还灵活地应对了 COVID-19 大流行的挑战，改变了编辑政策并出版了许多与 COVID 相关的关键手稿。

1924 年出版的《临床研究杂志》第一期目录。

在过去五年中，ASCI 新成员中来自外科领域、妇产科、流行病学和结果研究的科学家的代表性有所增加。Panels show percentages of newly elected members to ASCI by year from 2017 to 2021 compared with the five-year period between 2012 and 2016 for ( A ) new members from surgical fields and obstetrics and gynecology (Obgyn) and ( B ) new members from epidemiologic领域（Epi）和成果研究。

尽管国内和国际对医师科学家在推进医学科学中发挥的关键作用日益关注，但这一流行病也给医师科学家带来了有形和无形挑战的浪潮。封锁关闭了研究实验室，许多实验室仍然关闭或容量减少。许多学术中心已经停止或限制了与 COVID 无关的临床研究，并且恢复缓慢。关键实验室试剂和用品的短缺使重要项目停滞不前。在 COVID-19 患者激增期间，许多医师、调查人员和学员不得不搁置研究，以便承担更多的临床责任。尽管增加了临床工作，许多学术中心的收入受到严重影响，支持研究人员的过渡资金较少。在家里，许多调查人员不得不处理失去儿童保育、老人护理和其他重要服务，因接触、学校关闭和疾病而反复隔离，以及家人和朋友失业。这些困难尤其影响了年轻的研究人员，他们除了在科学事业中处于更脆弱的时期外，更有可能在家中有年幼的孩子；女性和少数族裔调查员也特别容易受到伤害。以及家人和朋友之间的失业。这些困难尤其影响了年轻的研究人员，他们除了在科学事业中处于更脆弱的时期外，更有可能在家中有年幼的孩子；女性和少数族裔调查员也特别容易受到伤害。以及家人和朋友之间的失业。这些困难尤其影响了年轻的研究人员，他们除了在科学事业中处于更脆弱的时期外，更有可能在家中有年幼的孩子；女性和少数族裔调查员也特别容易受到伤害。

事实上，全球大流行与 2018 年开始的#MeToo 运动以及 2020 年为抗议警察对黑人和其他少数族裔社区的暴行和暴力行为的广泛示威活动的交集，使科学和其他少数群体的系统性偏见和不平等问题成为焦点。医疗保健（4）。COVID-19 大流行对美国的少数族裔群体产生了不成比例的影响，包括黑人、西班牙裔和美洲原住民社区，感染率和死亡率均较高。然而，这些社区在推动对最严重疾病的临床护理的数据中基本上没有代表（5），这些少数群体在医学领域的代表性仍然不足，在医学科学家的行列中更是如此。例如，黑人占美国人口的 13%，但仅占美国医生的 4%，在医学科学家中的比例甚至更小（6）。然而，包括科学在内的各个领域都表明，增加的多样性会激发创造力和影响力（7）。

作为一个组织，我们为解决 ASCI 内的多样性和公平性而采取的第一步是在 2018 年成立一个多元化工作组，旨在修订和更新我们的使命宣言，使其更具包容性；该任务已于 2019 年完成，修订后的使命宣言可在 ASCI 网站上查看。简而言之，美国临床调查学会旨在支持医学科学家的科学努力、教育需求和临床愿望，以改善所有人的健康。修改我们使命的措辞是一回事，但实际上更具包容性是完全不同的一件事。这是正在进行的工作。作为一名女性医学科学家，我记得很多年前我第一次被提名为 ASCI 成员时，我翻阅了成员名册，并被女性和少数族裔的数量之少所震惊，并想知道在这个几乎完全由白人男性组成的社会中是否会有我的位置. 理事会与我们的机构代表合作，以增加被提名为会员的女性和代表性不足的少数族裔的人数。这项工作在我们的会员和领导层中都得到了回报（图 3），我很自豪能够在一个由女性占多数的委员会中担任 ASCI 的第八位女性主席，其中包括第一位黑人编辑 理事会与我们的机构代表合作，以增加被提名为会员的女性和代表性不足的少数族裔的人数。这项工作在我们的会员和领导层中都得到了回报（图 3），我很自豪能够在一个由女性占多数的委员会中担任 ASCI 的第八位女性主席，其中包括第一位黑人编辑 理事会与我们的机构代表合作，以增加被提名为会员的女性和代表性不足的少数族裔的人数。这项工作在我们的会员和领导层中都得到了回报（图 3），我很自豪能够在一个由女性占多数的委员会中担任 ASCI 的第八位女性主席，其中包括第一位黑人编辑JCI，Rex Ahima 博士，以及我们期刊的第一位女性编辑，JCI Insight编辑 Kathy Collins 博士。

在过去五年中，在 ASCI 的新成员中，医学或女性代表不足的医师科学家的比例有所增加。Panels show percentages of newly elected members to ASCI by year from 2017 to 2021 compared with the five-year period between 2012 and 2016 for ( A ) new members from racial or ethnic groups that are underrepresented in medicine (URM) and ( B ) new女性成员。

尽管取得了这些进展，我们还有很多工作要做。为了为下一次公共卫生危机做好准备，生物医学科学的迅速发展必须成为一股涨潮，掀起所有船只，提升和提升女性和少数医学科学家的职业生涯以及更大的科学界。2020 年，我们修订了 ASCI 的章程，成立了一个永久性的多元化公平和包容委员会，负责确保该组织、其计划及其指导机制促进和承认多元化、包容性和公平。该委员会由议员 Sophie Paczesny 博士担任主席。委员会正在处理的第一项任务是制定可用于调查我们成员资格的医学中代表性不足的群体的定义。尽管是一个科学家组织，令人惊讶的是，我们几乎没有关于我们成员的种族和民族构成的数据，而且直到最近才开始收集这些数据，作为提名过程的一部分。该委员会正在开展的其他项目包括新的指导计划和针对女性和代表性不足的调查人员的奖励。我希望在未来，年轻的研究人员在考虑自己的 ASCI 提名时细读 ASCI 成员的行列，他们会在这个医师-科学家社区中看到更多看起来像他们自己的面孔。

最后，关于“工会状况”，我可以向您保证，尽管发生了大流行，但 ASCI 在财政和组织上都继续蓬勃发展。尽管随着远程工作的继续，我们在安娜堡的社会办公室空无一人，而且我们的理事会也无法亲自聚会，但我们已经召开了虚拟会议，以开展我们社会的业务。我要感谢执行董事 John Hawley 和董事总经理 Karen Guth，他们管理 ASCI 超过 20 年。尽管新领导层的年度中断和每个新理事会的突发奇想，他们的集体机构记忆和稳定的掌舵人使 ASCI 保持在正常轨道上。我还要感谢 Kieren Marr 博士和 Kimryn Rathmell 博士，杰出的领导人和榜样，在我担任主席之前，他们的想法和意见塑造了安理会目前正在开展的许多积极项目。我将您交给我们即将上任的主席 Hossein Ardehali 博士，他为协会制定了许多令人兴奋的计划. I would also like to welcome our three newly elected Council members, Drs. Julie Bastarache、Goutham Narla 和 Elizabeth Speliotes。本·汉弗莱斯。I would also like to welcome our three newly elected Council members, Drs. Julie Bastarache、Goutham Narla 和 Elizabeth Speliotes。本·汉弗莱斯。I would also like to welcome our three newly elected Council members, Drs. Julie Bastarache、Goutham Narla 和 Elizabeth Speliotes。

最后，感谢您有机会在这个充满挑战的一年担任总裁。最后，我将欢迎我们的新成员。你正在加入一个虽然沉浸在传统中，但诞生于变化的社会。ASCI 将继续适应和发展，以应对不断变化的世界和不断变化的临床研究格局。我鼓励您利用这个社会中的机会进行交流，在我们的期刊上发表文章，并参与我们的委员会、机构代表和领导。

脚注

利益冲突： LBW 从基因泰克公司获得与本文内容无关的研究经费。

参考资料：J Clin Invest。2021;131(18):e154538。https://doi.org/10.1172/JCI154538。

本文改编自 2016 年 4 月 15 日在美国伊利诺伊州芝加哥举行的 2016 AAP/ASCI/APSA 联席会议上的演讲。

版权所有： © 2021，美国临床研究学会。

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